ABSTRACT
Physicians who treat musculoskeletal and neurologic disorders often treat patients who have paresthesias or weakness of a single extremity. Although the diagnosis is often straightforward, cases that are atypical in nature may pose a diagnostic dilemma. This report describes the case of a middle-aged man with symptoms indicative of, though not classic for, a cervical radiculopathy. An extensive investigation was unremarkable and only the eventual rapid progression of symptoms led to the diagnosis of a glioblastoma multiforme. Although this is a deadly form of brain cancer, early recognition provides the best chance for a prolonged and greater quality of life.
Subject(s)
Brain Neoplasms/diagnosis , Diagnostic Errors , Fingers/innervation , Glioblastoma/diagnosis , Paresthesia/etiology , Radiculopathy/diagnosis , Biopsy , Brain Neoplasms/complications , Brain Neoplasms/therapy , Diagnosis, Differential , Disease Progression , Electromyography , Glioblastoma/complications , Glioblastoma/therapy , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Neurologic ExaminationABSTRACT
OBJECTIVE: To assess whether knowledge or psychosocial and glycemic benefits of a diabetes education program are enhanced by a support group for older patients. DESIGN: A partially randomized controlled trial involving two groups of patients: Group A, subjects who received an education program followed by 18 months of support group sessions; Group B, only the diabetes education program. A third convenience sample, Group C, received neither intervention. Groups A and B were assessed before and immediately after the education program, and all groups were assessed 2 years after the education program. SETTING: Diabetes clinic at a Veterans Affairs Medical Center. PATIENTS: All subjects were male (mean age = 68 +/- 1.3 years, range = 57-82 years; duration of diabetes = 10 +/- 2 years, range 3-16). Sample sizes were 11 in Group A, 13 in Group B, and 8 in Group C. INTERVENTION: The education program consisted of six weekly sessions covering aspects of diabetes self-care. The support group consisted of 18 monthly sessions for continuing education, discussion, and structured social activities. OUTCOME MEASURES: Diabetes knowledge, psychosocial factors (self-care-related quality of life, stress, family involvement in care, and social involvement), depression, and glycemic control. RESULTS: Group A scored better (at least P less than 0.05) on knowledge, quality of life, and depression than the other groups. Groups A and B showed less stress, greater family involvement, better glycemic control, but less involvement in social activities than Group C. CONCLUSION: Diabetes education programs can have long term benefits on knowledge, psychosocial functioning, and glycemic control for older diabetic patients. The addition of support groups enhances diabetes knowledge and psychosocial functioning.
